Sex differences in pain

Berkley, Karen J.

doi:10.1017/s0140525x97221485

Cited by 1,125Pain Mechanisms and TreatmentsSex and Gender in HealthcarePain Management and Placebo Effect

Sex differences in pain

Berkley, Karen J.·1997·Behavioral and Brain Sciences

DOI 10.1017/s0140525x97221485

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Abstract

Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is "learned" and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production.

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Females have fewer experiences that inure them to fear of self-injury and lower pain and fear tolerance than males, so they may be less able to develop acquired capability for suicidal behavior.
“However, because females on the whole have fewer experiences that inure them to fear of self-injury (e.g., exposure to guns, physical fights, violent sports, etc.), and because they have lower pain and fear tolerance than males (Berkley, 1997), they may be less able to develop the acquired capability for suicidal behavior than are males.”
From The interpersonal theory of suicide. (2010) · cites this paper as Berkley, 1997
Women are more sensitive to pain in laboratory settings.
“Basic research in laboratory environments show that women are more sensitive to pain [14–16]”
From Chronic pain and sex-differences; women accept and move, while men feel blue (2017) · cites this paper as [14]

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Authors: Berkley, K. J.
Affiliations: Florida State University (US)
Corresponding author: Berkley, Karen J.
Venue: Behavioral and Brain Sciences
Publisher: Cambridge University Press (CUP)
Published: 1997-09
Volume: 20
Issue: 3
Pages: 371-380
ISSN: 0140-525X (ISSN-L)
1469-1825
DOI: 10.1017/s0140525x97221485
OpenAlex: W2168132586
Cited by: 1,125
References: 0
Citations by year: 2026: 8 · 2025: 17 · 2024: 30 · 2023: 31 · 2022: 42 · 2021: 32 · 2020: 27 · 2019: 32 · 2018: 28 · 2017: 30 · 2016: 39 · 2015: 33 · 2014: 44 · 2013: 48 · 2012: 39
FWCI: 14.24
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Behavioral and Brain Sciences (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Keywords: sex differences in pain, pain perception, pain threshold, pain tolerance, sex hormones, hyperalgesia, opioid system, nerve growth factor, sympathetic nervous system, pain coping, pain reporting
MeSH terms: Adult, Female, gamma-Aminobutyric Acid, Humans, Male, Middle Aged, Nerve Growth Factors, Pain, Pain Measurement, Sex Characteristics, Sex Factors, Gonadal Steroid Hormones, Sympathetic Nervous System

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